In this expert guide from Physiostation, you will hopefully understand what a tendon is, why tendons can become painful, and what you can do to help prevent and/or improve tendon pain. 


 What are tendons?

Tendons are strong cord like structures which attach muscles to bones throughout the body.  They are well designed to cope with a large amount of load (or strain) we put through them e.g. running.  Sometimes, however, we can develop pain from the tendons.

achilles

Tendon pain

Tendon pain is common and often difficult to settle down.  It used to be believed that the tendon was inflamed and hence it was called ‘tendonitis’.  For over three decades now researchers have known that it is actually not likely to be inflamed.  This has brought about a different diagnostic word, called ‘tendonopathy’.  Basically, this means a pathology (problem) of the tendon.

What causes Tendon pain?

The simplest explanation is that there is a failed response of the tendon to adapt itself to the loads placed upon it with daily activities and/or sport.  This is largely because tendons aren’t very good at responding quickly to change due to the blood flow not being as good as some other parts of the body.  Typically, for example, if we increase our training programme very suddenly, our tendons may not be able to adapt quickly enough to bring in the required amount of nutrients it needs, and hence can then react and produce pain.  This is our body’s way of telling us the tendon needs a bit more time to adapt and, as a result, cope better with the increased demands placed upon it.

Alterations in tendon strain can come from other sources too, such as wearing a different pair of running shoes or training on a different surface to normal.  Even if its not related to Sport, a sudden change in our normal daily activities can also cause the tendons to react.

Although this guide has primarily focused on the achilles (heel) tendon, these reactions can occur in any tendon throughout the body.  Other common areas affected are the elbow (tennis/golfers elbow), shoulder, wrist, and knee.  For example, if we do a an intense period of decorating, our shoulder tendons may react and become painful.  Remember this is our body’s way of saying we’ve done something different to normal, and not necessarily an indication of structural damage.

decorating

How can it be improved?

Early recognition of the problem and then taking appropriate action is the key to speed up recovery time.  In the early stage, modifying or reducing your activities which load the tendon will give it the best chance to adapt itself accordingly to cope with these increased loads.  This should only take between a few days and a few weeks.  We wouldn’t recommend complete rest as this is not normal for the tendons and they can struggle to get back active again.

running
It’s better to keep up with your normal activities as much as possible, albeit to a reduced level if necessary. Conversely, if we continue to intensively train on/intensely load the tendon when it is reacting, it won’t be able to adapt itself to cope with the demands.  This can result in a poorly conditioned tendon as it struggles to get the nutrients it needs.  In this situation, the tendon can be painful for several months.

If you are unfortunate to already have tendon pain which has persisted for several months, the advice would be to seek the opinion of a Chartered Physiotherapist.  This is because everyones situation is different, so the recovery/treatment programme needs to be individualised and specific to your needs.  At Physiostation, our Chartered Physiotherapists are highly experienced at treating these problems.  Please feel free to get in touch with us for further information.

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